Current long term care system for elderly
Public long term care is delivered through a mix of programs, with eligibility and coverage varying from one state to another. Eligibility is based mostly on income and personal resources.
Program and nature of coverage
Medicaid: a means-tested safety net for low-income elderly dependents.
Medicare: social insurance for elderly dependents aged 65 and above Private long term care insurance: purchased either by individuals or as employer-sponsored group insurance policies for long term care
Nature of benefit coverage
Medicaid: covers both home and institutional care. Some types of care are mandatory and must be covered in all states; others are optional and may be provided only in states that elect to do so.
Medicare: provides nursing homes and home health services for a short period of time, following an acute event Private long term care insurance: services covered vary according to the policy purchased.
Source of funding
Medicaid: joint federal and state funding.
Medicare: partly funded through payroll and income tax and the remaining from Medicare premiums and taxpayer funds Private long term care insurance: paid by individuals or employers (preferential tax treatment available).
Reforms initiated/ future direction
Over time, at a state and local level, the US introduced healthcare system innovations and reforms to improve access to affordable long-term elderly care and enhance cost efficiency of the healthcare system.
Initiatives such as the Program of All-Inclusive Care for the Elderly (PACE) have helped reduce hospital stay and delay assignments to nursing homes.
Recently, Congress established a Commission to recommend reforms to the current LTC system. The Commission has been established to address three key issues – long term care financing, delivery, and workforce challenges.